Pudendal nerve block insurance help

[Mushermellon]

I have BC/BS federal. I am new with the disorder, with it coming in suddenly this year, Feb. 2024. I have a pudendal neuralgia dx from a local provider, with no one local agreeing to see me. Hibner (AZ) confirmed diagnosis on telehealth, suggesting a nerve block. Anyone have any luck getting this covered by insurance? He no longer bills insurance at his clinic and I have been told that very little, if any, will be reimbursed, and I’m afraid to see how it will work there at the hospital. How do we navigate this? Thanks!

[Violet M]

I have been told that very little, if any, will be reimbursed, and I’m afraid to see how it will work there at the hospital. How do we navigate this? Thanks!

Did BCBS tell you it wouldn't be covered by insurance? If not, you could check with the provider where you are thinking of getting the nerve block done and request the CPT codes to get preauthorization from BCBS.

If they won't cover it, you could try an appeal using peer reviewed articles that you find on pubmed on the topic of pudendal nerve blocks.

Violet

[Mushermellon]

Thank you! No, BC/BS hasn’t said that, but Hibner’s billing person pays it’s highly unlikely. I’ll check into that. In your experience how far up do I need to talk to someone at BC/BS. Just the first person I talk to?

[Violet M]

It would probably be a good idea to request the authorization in writing via a letter rather than taking someone's word for it over the phone. I'm not sure how high up you would have to go for that but hopefully the first person you talk to can tell you the process for getting that letter. But you would have to get the CPT codes from the physician's office where you are having the procedure done.

Violet